Specialty Care

Assess care summaries received from primary care providers to inform and evaluate prior authorization requests

Review previous primary care office notes, active problems and chronic conditions, laboratory results, radiology reports, and hospital and procedure notes to inform consultation visits

Enhance patient confidence and satisfaction by engendering greater collaboration with referring providers

Confirm correct medication lists during transitions of care by reviewing filled/dispensed medications (over last 120 days)

Prevent duplication of medications after discharge to avoid overprescribing, eliminating redundancies and extra costs

Monitor medications to prevent misuse and risk of harm Identify potentially adverse drug combinations/interactions and/or dosing levels

Establish clear communication with primary care providers and other treating providers from unaffiliated locations through real-time updates to shared care plans

Ensure timely communication of events across all treating providers via electronic notification alerts to ensure rapid follow-on action and informed decision-making

Facilitate future referrals and monitor at-risk patients’ progressions between professional settings to guarantee follow through on recommended actions

Assemble comprehensive discharge care plans including review of medications, identification of necessary follow-up services and office visits, description of relevant equipment needs, and recommendation of home care services, as needed

Assure seamless transitions of care to various care settings according to each patient’s specific health needs and risks by facilitating accurate interpretation of discharge instructions

Support and ensure successful care coordination during transitions through improved communication and care planning

Support various performance reporting initiatives by providing access to a centralized and comprehensive clinical data repository to fill in data gaps and longitudinal information

Produce a variety of quality, utilization, and predictive risk measures to help providers identify weaknesses, prioritize opportunities and identify improvement areas

Track health outcomes and equity based on both clinical and community activities and determinants of health and wellbeing

Provide quality measurement support for Hospital Readmission Reduction Program (HRRP), CMS Core Measure Set, and National Quality Forum (NQF) reporting efforts